We need to talk about IUDs and copper toxicity

Copper toxicity IUD

Discovered in the late 70s as a form of emergency contraception, the copper IUD is the most effective non-hormonal form of long-term and emergency birth control currently available.1 For women who can’t tolerate hormonal contraception, it can be a godsend.

While the invasive insertion process can be uncomfortable— as an IUD sits inside the uterus and enters through the cervix — once it’s in, it’s in, and you don’t need to think about it for at least the next five years. But the process isn’t always that simple.

While painful periods and a small risk of infection are well-known side effects of the copper IUD,2 the risk of copper toxicity is spoken about less often.

As part of an IUD device, copper acts as a type of spermicide, making the uterus environment inhospitable to sperm so it can’t successfully fertilise an egg. Copper exists inside the body as an essential mineral at low levels without being harmful.3 A safe range for copper levels inside the bloodstream is 70-140mg per deciliter,4 and a low level of copper inside the body is needed for the function of joints, ligaments and bones.5 Copper toxicity happens when these levels surpass the upper limit that’s considered safe.

How common is copper toxicity?

“Copper poisoning can happen, but in a majority of women using the IUD, they don’t experience any problems associated with copper toxicity,” says consultant pharmacist James O’Loan. “In healthy women, the copper IUD is a safe method for those that can’t take hormonal birth control for whatever reason.”

Toxicity from high levels of copper caused by an IUD is considered extremely rare, though there are reported cases. For women who have pre-existing conditions that affect the liver’s ability to process minerals like copper, GP Dr Cichi says the likelihood of copper toxicity from an IUD is slightly increased.

“Copper toxicity, or copper poisoning causes symptoms such as headaches, fever, fainting, nausea, vomiting, blood in your vomit, diarrhoea, black stools, abdominal cramps, brown rings in the eyes, and jaundice”

James stresses that while copper toxicity from an IUD is unlikely, all women should still be aware of the signs and symptoms to look out for.

“Copper toxicity, or copper poisoning causes symptoms such as headaches, fever, fainting, nausea, vomiting, blood in your vomit, diarrhoea, black stools, abdominal cramps, brown rings in the eyes, and jaundice. It’s worth being aware of these in case your body is susceptible to copper retention.”

Dr Cichi points out that there could be a link between excess levels of copper from an IUD device and excess levels of oestrogen, though this possible link is poorly understood.

“Copper and oestrogen are closely related, which could be why both are used in different methods of contraception. However, it’s not yet clear whether excess oestrogen can cause copper retention in women that use the non-hormonal IUD,” he says. “There is a possibility of this happening, but it isn’t clear how common it is.”

Research isn’t reflecting women’s experiences

While the current science is clear that copper toxicity is extremely unlikely in healthy women, the experiences of some women point towards more research being needed.6 Sadie Petiford opted for the ParaGard, a make of IUD available in the US, at 23-years-old, after hormonal contraception gave her severe acne and her partner didn’t want to use condoms anymore.

“I wanted to be a ‘good girlfriend’, and felt pressured as a woman,” she explains. “I had no luck finding [a Planned Parenthood that would fit] a diaphragm, so felt backed into a corner with a copper IUD as my only option because it was touted as ‘hormone free’, so wouldn’t cause acne.

“It seemed like the perfect option. I don’t have Wilson’s disease or any known copper allergy. I was basically the so-called ‘perfect candidate’ since they recommend it for women who struggle with hormonal birth control. I had no problem finding a provider to insert it.”

Sadie wasn’t warned about the risk of copper toxicity when she had her IUD inserted

Wilson’s disease, along with liver disease, thyroid issues, lymphoma, hepatitis, anemia, leukaemia, and rheumatoid arthritis “bring an increased risk of copper poisoning”, says Dr Cichi. He highlights the importance of speaking to your GP if you have any of these conditions and you’re considering a copper IUD.

“If you have any of these conditions but would still like to try an IUD, there are also hormonal options that release progesterone that may be safer for you,” he says.

Sadie wasn’t warned about the risk of copper toxicity when she had her IUD inserted, but was later told that because copper is a reactive mineral and it works as birth control by oxidising, it wouldn’t be used in any other medical procedure.

“I didn’t look any further than ParaGard’s and Planned Parenthood’s website, and didn’t know anybody personally at the time who had used it,” she says. “What I didn’t notice was the small print at the bottom of their prescribing information that says ‘this is not a complete list of possible side effects’.

“There is no complete list.”

Sadie describes her copper toxicity symptoms as having “crept in subtley after a month”. She had “forgotten” about her IUD and “never would have attributed her symptoms to it if they hadn’t got so bad”.

“I had no idea what was going on,” she says. “I actually checked myself into therapy because I thought it was me. In hindsight, I can now say it was giving me racing dark thoughts, but at the time I blamed it on my childhood, relationships, past experiences, and a medicine I was taking for migraines.

“It changed me into a completely different person.”

“I had never been to therapy before the IUD and had no prior mental health diagnosis, yet suddenly I was being misdiagnosed with OCD and what the therapist later said ‘looked like schizophrenia’ too”

At one point, Sadie became severely suicidal, and was told she had obsessive compulsive disorder (OCD), and possibly schizophrenia.

“I had never been to therapy before the IUD and had no prior mental health diagnosis, yet suddenly I was being misdiagnosed with OCD and what the therapist later said ‘looked like schizophrenia’ too,” she says. “I was put on high dose antidepressants, but since having the IUD removed, I haven’t needed to be on anything since.”

Six months after having her ParaGard inserted, something clicked, and Sadie began looking into the possibility of it being the cause of her mental health issues, that had seen her lose her job. When she asked her OB GYN about the possibility of her anxiety being linked to her IUD, she was told it wasn’t a possibility since the body’s reactions to copper “all stay in the uterus”. It wasn’t until she began having heart palpitations that were “hummingbird fast” that she decided it was time to get it taken out.

“I honestly might have died had I not done that. I found information on copper toxicity and it matched every one of the symptoms I had since the insertion of the IUD,” says Sadie.

She was initially belittled and not taken seriously by healthcare professionals, and recalls her OB GYN “rolling her eyes during the removal process”. Her therapist even told her to take the possibility of copper toxicity with “with a grain of salt” before eventually referring her to a doctor that listened and acknowledged her experience.

After this, Sadie was referred to the Hall Centre in Santa Monica, where she was put on a regimen of zinc, selenium, vitamin C, and PectaSol-C to chelate — the process of removing heavy metals from the body — the copper from her system. She “felt herself again” within eight months. The severe depression, mania, tremors, and chronic obsessive dark thoughts she’d been struggling with for months all resolved themselves.

“I no longer have any of these symptoms, but the damage they did has left me with a loss of visual creative thinking and some noticeable memory loss,” she says. “I had to fight hard after getting it out to rebuild my personality from scratch. I lost everything, including my job.”

Sadie doesn’t feel the issue of copper toxicity from IUDs is taken seriously in mainstream gynaecology and would label the severity of the problem as a human rights issue. Non-hormonal copper IUDs haven’t yet been linked to depression or other mental health problems by large-scale research.

The bodily functions that help the human body to regulate levels of copper can also cause symptoms that are misdiagnosed as psychiatric disorders, because if they are overworking to filter out excess copper by binding it in plasma to prevent it being absorbed by tissue, they aren’t able to perform their original functions effectively.7,8

“Some women that I have talked to have even had their kids separated from them for a period of time while they had the copper IUD in”

Much like Sadie’s experience, this can cause symptoms like depression, mania, suicidal thoughts, personality changes, uncharacteristic behaviour, anxiety, and even delusions and hallucinations.9,10 Research into the roles copper and zinc alloys play in neurological, endocrinological, and psychological conditions has been widespread, though not specifically involving copper IUDs.

“I suspect in the next decade this will be more common and well-known, but for now women have to be their own advocates, do their own research, and seek out knowledgeable care and resources. I have since spread awareness on Instagram and I have gotten responses from women from all over. Some women that I have talked to have even had their kids separated from them for a period of time while they had the copper IUD in,” says Sadie.

“It’s absolutely heartbreaking.”

The featured image is of three different types of copper IUD, the Mona Lisa, GyneFix, and ParaGard (left to right). The background has been coloured blue for dramatic effect

Page last updated August 2019

References

  1. Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health. 2010 Aug 9;2:211-20. PubMed
  2. NICE, ‘Contraception – IUS/IUD’, Clinical Knowledge Summary, National Institute for Health and Care Excellence, May 2019, [online], https://cks.nice.org.uk/contraception-iusiud#!scenarioRecommendation:10 (accessed 16 August 2019)
  3. Scheiber, I., Dringen, R., & Mercer, J. (2013). Copper: Effects of Deficiency and Overload. Metal Ions in Life Sciences, 359-387.
  4. Health Encyclopedia, ‘Total Copper (Blood)’, University of Rochester Medical Center, [online], https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=total_copper_blood (accessed 16 August 2019)
  5. Scheiber, I., Dringen, R., & Mercer, J. (2013). Copper: Effects of Deficiency and Overload. Metal Ions in Life Sciences, 359-387.
  6. Imani, S., et al., ‘Changes in copper and zinc serum levels in women wearing a copper TCu-380A intrauterine device’, Eur J Contracept Reprod Health Care, vol. 19, no. 1, 2013, pp. 45-50. 2013.
  7. Desai, V., & Kaler, S. (2008). Role of copper in human neurological disorders. The American Journal of Clinical Nutrition, 88/3: 855S-858S.
  8. Litwin, T., Dusek, P., Szafrański, T., Dzieżyc, K., Członkowska, A., & Rybakowski, J. (2018). Psychiatric manifestations in Wilson’s disease: possibilities and difficulties for treatment. Therapeutic Advances in Psychopharmacology, 8/7: 199-211.
  9. ibid
  10. BLT, ‘Wilson’s Disease’, British Liver Trust, [online], https://www.britishlivertrust.org.uk/liver-information/liver-conditions/wilsons-disease/ (accessed 16 August 2019)

Rachel Mantock

Deputy Editor, The Femedic

A feature writer who started out in lifestyle and wellness, Rachel joined The Femedic after becoming frustrated with the way women’s bodies and intimate health were being reported on. She wanted to talk about the good, the bad, the ‘ugly’ and the ‘really ugly’, with no topic too taboo to investigate. From conversations with the women she meets everyday to speaking with doctors, she’s constantly surprised by the amount of misinformation and lack of research around women’s health issues. She’s determined to raise awareness of the female health issues that are prominent in minority groups and to get more women talking shamelessly about their bodies and experiences.

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